Complex Medication Review

1. Complex Medication Review Robert Hallworth Chair – Greater Manchester Non-Medical Prescribing Network Oldham Primary Care Trust

2. The Levels of Medication Review Level 3 – Clinical Medication Review Level 2 – Concordance & Compliance Review Level 1 – Prescription Review Level 0 – Ad Hoc

3. Medication Review - particular risk groups identified in Older People NSF • Those on 4 or more medicines • Post-discharge from hospital • In care homes • Where medicine-related problems have been identified • Patients over 75 • Following an adverse change in health

5. Patient CB • Paracetamol – under dose? • Gaviscon – under dose? • Prochlorperazine – under dose? Adverse effects? • Propranolol – interaction with diltiazem? • Pholcodine – under dose? Adverse effects?

6. Patient CB • Clopidogrel – indication? Adverse effects? • Dilitiazem – adverse effects? • Monomax – dose timing • Bezafibrate – use with a statin? • Quinine bisulphate – indication? • Metformin – what is the intended dose?

7. Patient CB • Lansoprazole Fastabs – Dose. Cost effectiveness • Furosemide – indication • Nicorandil – is it needed? Adverse effects? • Terbinafine – course length • Ferrous sulphate – indication. Adverse effects.

8. Patient RK • BP control • Diabetes control • Weight – orlistat? • GI symptoms • Nicorandil • Lipid modification • Smoking • Asthma

9. Patient RK • Angina • Depression / mental health • Pain • Monitoring – BP, HbA1C, BG, U&Es, lipids, LFTs, PEFR

10. The NO TEARS tool Need and Indication Open questions Tests and Monitoring Evidence and Guidelines Adverse Events Risk Reduction or Prevention Simplification and Switches

11. Questions? Thank you Robert.Hallworth@nhs.net